Provider Demographics
NPI:1801888177
Name:WENDT, BARRY J (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:WENDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-341-0288
Mailing Address - Fax:859-341-7482
Practice Address - Street 1:2900 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5427
Practice Address - Country:US
Practice Address - Phone:859-341-0288
Practice Address - Fax:859-344-7482
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34218207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0403621OtherUNITED HEALTHCARE
KYP00922879OtherRAIL ROAD MEDICARE
000000215381OtherANTHEM
310674100OtherUS DEPT OF LABOR
IN200916610Medicaid
OH2021378Medicaid
310674100OtherFEDERAL BLACK LUNG
50006694OtherPASSPORT
967923OtherAETNA
KY64958036Medicaid
KY64958036Medicaid
P00205896Medicare PIN
KYP00028994Medicare PIN
50006694OtherPASSPORT
310674100OtherFEDERAL BLACK LUNG
KY0655059Medicare PIN
310674100OtherUS DEPT OF LABOR
KY3400140Medicare PIN
000000215381OtherANTHEM